0000000000173123
AUTHOR
Pilar Merlos
Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction.
Abstract Introduction and objectives A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. Methods One week after a first ST-segment elevation myocardial infarction we carried out a comp…
Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure.
Aims Continuous ambulatory peritoneal dialysis (CAPD) has been proposed as an additional therapeutic resource for patients with advanced congestive heart failure (CHF). The objective of this study was to determine the therapeutic role of CAPD, in terms of surrogate endpoints, in the management of patients with advanced CHF and renal dysfunction. A total of 57 candidates with New York Heart Association (NYHA) class III/IV CHF, renal dysfunction (glomerular filtration rate , 60 mL/min/1.73 m 2 ), persistent fluid congestion despite loop diuretic treatment, and at least two previous hospitalizations for acute heart failure (AHF) were invited to be included in the CAPD programme; however, 25 pa…
Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction.
Neutrophil to lymphocyte ratio (N/L) has been associated with poor outcomes in patients who underwent cardiac angiography. Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/L max) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBC max). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hour…
Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels.
Risk stratification of patients with acute chest pain, non-diagnostic electrocardiogram and normal troponin (ACPneg) remains a challenge, partly because no standardized set of biomarkers with prognostic ability has been identified in this population. Lymphopenia has been associated with atherosclerosis progression and adverse outcomes in cardiovascular diseases; although its prognostic value in ACPneg is unknown. We sought to determine the relationship between the lymphocyte count obtained in the Emergency Department (ED) and the risk of the long-term all-cause mortality or myocardial infarction (MI) in patients with ACPneg.We analyzed 1030 consecutive patients admitted with ACPneg in our i…
Usefulness of pain presentation characteristics for predicting outcome in patients presenting to the hospital with chest pain of uncertain origin
Background Decision making in chest pain of uncertain origin is challenging. Objectives To evaluate the predictive value of simple characteristics of pain presentation in patients coming to the emergency department with chest pain and without electrocardiogram ischaemia or raised troponin. Methods 789 patients were studied. The following categorical pain characteristics were collected: effort related pain, pressing character, radiation, associated symptoms, and ≥2 episodes in 24 h. Additionally, a predefined semi-quantitative pain score including seven items (Geleijnse score) was completed. Risk factors and co-morbidities were also recorded. The primary and secondary endpoints were cardiac …
Effect of invasive treatment on prognosis in non-ST-segment elevation acute coronary syndrome with or without systolic dysfunction.
Introduction and objectives. Few data are available on the use of invasive treatment in patients with non-STsegment elevation acute coronary syndrome (NSTEACS) and systolic dysfunction. The aim of this study was to determine the effect of invasive treatment on the prognosis of patients with NSTEACS, with or without systolic dysfunction. Methods. The study included 972 consecutive patients admitted for NSTEACS (i.e. ST-segment depression or an elevated troponin-I level). Systolic dysfunction was defined as an ejection fraction <50% on transthoracic echocardiography. The primary long-term endpoint was death or myocardial infarction. The effect of invasive treatment on prognosis was evaluated …
Efecto pronóstico de una estrategia terapéutica guiada por los valores del antígeno carbohidrato 125 (CHANCE-HF). Diseño del estudio
Resumen Introduccion y objetivos La morbilidad y la mortalidad despues de un ingreso por insuficiencia cardiaca aguda siguen siendo extremadamente elevadas. En este contexto, se ha demostrado que las concentraciones plasmaticas del antigeno carbohidrato 125 muestran correlacion con la gravedad de la sobrecarga hidrica y el riesgo de muerte y reingreso. Los datos preliminares indican un posible papel del antigeno carbohidrato 125 como guia para el tratamiento. El objetivo de este estudio es evaluar el efecto pronostico de una estrategia de tratamiento guiada por el antigeno carbohidrato 125 comparada con el tratamiento estandar en pacientes dados de alta recientemente tras un ingreso por ins…
Continuous ambulatory peritoneal dialysis and clinical outcomes in patients with refractory congestive heart failure.
A B S T R A C T Introduction and objectives: Peritoneal dialysis has been proposed as a therapeutic alternative for patients with refractory congestive heart failure. The objective of this study was to assess its effect on long-term clinical outcomes in patients with advanced heart failure and renal dysfunction. Methods: A total of 62 patients with advanced heart failure (class III/IV), renal dysfunction (glomerular filtration<60 mL/min/1.73 m 2 ), persistent fluid congestion despite loop diuretic treatment and at least 2 previous hospitalizations for heart failure were invited to participate in a continuous ambulatory peritoneal dialysis program. Of these, 34 patients were excluded and adj…
Low lymphocyte count in acute phase of ST-segment elevation myocardial infarction predicts long-term recurrent myocardial infarction
Objective We sought to determine the relationship between the lowest lymphocyte count (lymphocyte(min))obtained within the first 96 h of symptoms onset and the risk of postdischarge recurrent spontaneous myocardial infarction (re-MI) in patients admitted with ST-segment elevation MI (STEMI). Methods We analyzed 549 consecutive patients admitted with STEMI from a single academic hospital. Lymphocyte counts were determined at admission and routinely during the first 96 h. Lymphocyte(min) was selected as the main exposure. Patients with inflammatory or infectious diseases, in-hospital death, or reinfarction were excluded from the analysis (final sample= 426 patients). Lymphocyte(min) was divid…
Predictors of cardiovascular magnetic resonance-derived microvascular obstruction on patient admission in STEMI
Early stratification of patients according to the risk for developing microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) is desirable. We aimed to identify predictors of cardiovascular magnetic resonance (CMR)-derived MVO from clinical+ECG, laboratory and angiographic parameters available on admission.Characteristics available on admission were documented in 97 STEMI patients referred for primary angioplasty. MVO was determined using contrast-enhanced CMR.MVO was present in 44 patients (45%). The C-statistic for predicting MVO was: clinical+ECG (.832), laboratory (.743), and angiographic parameters (.669). Adding laboratory to clinical+ECG information d…
Impacto pronóstico de una estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST según la presencia o no de disfunción sistólica
Introduccion y objetivos Escasa evidencia respalda la implantacion de una estrategia invasiva (EI) en pacientes con sindrome coronario agudo sin elevacion del segmento ST (SCASEST) y disfuncion sistolica (DS). El objetivo de este trabajo es evaluar el impacto pronostico atribuible a una EI en sujetos con SCASEST segun tengan DS o no. Metodos Se incluyo a 972 pacientes consecutivos ingresados por SCASEST (descenso del segmento ST y/o elevacion de troponina I). Se definio la DS como fraccion de eyeccion Resultados El 23,4% presento DS. Un total de 303 (31%) pacientes alcanzaron el objetivo primario, hecho que fue mas frecuente en los pacientes con DS (el 49,8 frente al 25,5%; p Conclusiones L…
Carbohydrate Antigen-125–Guided Therapy in Acute Heart Failure
Abstract Objectives This study sought to evaluate the prognostic effect of carbohydrate antigen-125 (CA125)–guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF). Background CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding. Methods In a prospective multicenter randomized trial, 380 patients discharged for AHF and high CA125 were randomly assigned to the CA125 strategy (n = 187) or SOC (n = 193). The aim in th…
Hyperuricemia in acute heart failure. More than a simple spectator?
Hyperuricemia is a prevalent condition in chronic heart failure (CHF), describing increased oxidative stress and inflammation. Although there is evidence that serum uric acid (UA) predicts mortality in CHF, its role as a prognostic biomarker in acute heart failure (AHF) has not yet been well assessed. The aim of this study was to determine if UA levels predict all-cause mortality. Additionally, as a secondary endpoint we sought the clinical predictors of UA serum level in this population.We analyzed 560 consecutive patients with AHF admitted in a single university center. UA (mg/dl) was measured during early hospitalization. Patient survival status was followed up after discharge (median fo…
Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes
Introduction and objectives: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Methods: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angi…
Differential prognostic effect of systolic blood pressure on mortality according to left-ventricular function in patients with acute heart failure.
Aims To evaluate the relationship between systolic blood pressure (SBP) and long-term mortality in patients with acute heart failure (AHF) stratified by ejection fraction (LVEF): reduced (≤40%) vs. preserved (≥50%). Methods and results We studied 1049 consecutive patients admitted with AHF. Systolic blood pressure was determined in the emergency department. Left-ventricular ejection fraction was categorized as ≤40% (n = 288), 41–49% (n = 174), or ≥50% (n = 587). Cox regression analysis was used for multivariable analysis. Mean age and SBP were 73 ± 11 years and 150 ± 36 mmHg, respectively. During a median follow-up of 18 months, 290 deaths (33.1%) were identified. Higher SBP was associated …
Diálisis peritoneal ambulatoria continua y evolución clínica de pacientes con insuficiencia cardiaca congestiva refractaria
Introduccion y objetivos Se ha propuesto el empleo de la dialisis peritoneal como alternativa para los pacientes con insuficiencia cardiaca congestiva refractaria. El objetivo de este estudio es evaluar su efecto en la evolucion clinica a largo plazo de los pacientes con insuficiencia cardiaca avanzada y disfuncion renal. Metodos Se invito a un total de 62 pacientes, con insuficiencia cardiaca avanzada (clase III/IV), disfuncion renal (filtrado glomerular < 60ml/min/1,73 m2), congestion persistente por exceso de liquidos a pesar del tratamiento con diureticos de asa y al menos dos hospitalizaciones previas por insuficiencia cardiaca, a participar en un programa de dialisis peritoneal ambula…
Insuficiencia cardiaca aguda post-alta hospitalaria tras un síndrome coronario agudo sin elevación del segmento-ST y riesgo de muerte e infarto agudo de miocardio subsiguiente
Introduccion y objetivos. La informacion disponible acerca del impacto pronostico de un episodio de rehospitalizacion por insuficiencia cardiaca aguda (ICA) tras un sindrome coronario agudo sin elevacion del segmento ST (SCASEST) es escasa. El objetivo de este trabajo fue evaluar el valor pronostico atribuible a un primer ingreso por ICA en cuanto a riesgo de infarto agudo de miocardio (IAM) y mortalidad en pacientes supervivientes a un episodio de SCASEST de alto riesgo. Metodos. Analizamos consecutivamente a 972 pacientes supervivientes a la fase hospitalaria de un SCASEST de alto riesgo. El reingreso por ICA se considero como la variable principal de estudio, y su asociacion con IAM y mo…
Efficacy of coronary revascularization in patients with acute chest pain managed in a chest pain unit.
To investigate the safety of discharge of patients deemed at low risk of cardiac events after evaluation in a chest pain unit and to determine the prognostic effect of revascularization of patients deemed at high risk.The study population consisted of 1088 patients presenting at the emergency department from January 15, 2001, to September 1, 2006, with chest pain but without ischemia on electrocardiography or troponin elevation. Patients were managed by a chest pain unit protocol that included early exercise testing. Three groups of patients were distinguished: (1) those discharged after exercise testing (424 [39%]); (2) those in whom unstable angina was ruled out after in-hospital evaluati…
Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease
Abstract Objectives This study explored the association of ischemic burden, as measured by vasodilator stress cardiovascular magnetic resonance (CMR), with all-cause mortality and the effect of revascularization on all-cause mortality in patients with stable ischemic heart disease (SIHD). Background In patients with SIHD, the association of ischemic burden, derived from vasodilator stress CMR, with all-cause mortality and its role for decision-making is unclear. Methods The registry consisted of 6,389 consecutive patients (mean age: 65 ± 12 years; 38% women) who underwent vasodilator stress CMR for known or suspected SIHD. The ischemic burden (at stress first-pass perfusion imaging) was com…
Differential mortality association of loop diuretic dosage according to blood urea nitrogen and carbohydrate antigen 125 following a hospitalization for acute heart failure.
Recent observations in chronic stable heart failure suggest that high-dose loop diuretics (HDLDs) have detrimental prognostic effects in patients with high blood urea nitrogen (BUN), but recent findings have also indicated that diure- tics may improve renal function. Carbohydrate antigen 125 (CA125) has been shown to be a surrogate of systemic congestion. We sought to explore whether BUN and CA125 modulate the mortality risk associated with HDLDs following a hospitalization for acute heart failure (AHF). Methods and results We analysed 1389 consecutive patients discharged for AHF. CA125 and BUN were measured at a mean of 72+12 h after admission. HDLDs (≥120 mg/day in furosemide equivalent d…
Therapeutic implications of low lymphocyte count in non-ST segment elevation acute coronary syndromes
Abstract Background Low lymphocyte count (LLC), a surrogate for inflammation, has emerged as a potential risk factor for cardiovascular outcomes, especially new ischemic events. To identify patients with non-ST segment elevation acute coronary syndromes (NSTEACS) who benefit from an invasive revascularization strategy remains a challenge. We sought to determine if patients with high-risk NSTEACS who exhibited LLC have a greater reduction in long-term post-discharge myocardial infarction (MI) when managed under a revascularization invasive strategy (RIS) as compared with conservative strategy (CS). Methods Nine hundred seventy two consecutive patients with high-risk NSTEACS were treated unde…
Valor pronóstico a largo plazo del análisis completo de los índices de resonancia magnética cardiaca tras un infarto de miocardio con elevación del segmento ST
Resumen Introduccion y objetivos Se ha demostrado el valor pronostico de varios indices de resonancia magnetica cardiaca a medio plazo tras un infarto agudo de miocardio con elevacion del segmento ST. La extension de la necrosis transmural permite una prediccion simple y exacta de viabilidad miocardica. Sin embargo, se desconoce su valor pronostico a largo plazo mas alla de una completa evaluacion clinica y por resonancia. Nuestra hipotesis es que la evaluacion semicuantitativa de la extension de la necrosis transmural es el mejor indice de resonancia para predecir el pronostico a largo plazo tras un infarto con elevacion del segmento ST. Metodos Se realizo un estudio cuantitativo con reson…
Effect of acute heart failure following discharge in patients with non-ST-elevation acute coronary syndrome on the subsequent risk of death or acute myocardial infarction.
Little is known about how prognosis is influenced by readmission for acute heart failure (AHF) following non-ST-segment elevation acute coronary syndrome (NSTEACS). The aim of this study was to determine the prognostic effect of a first admission for AHF on the risk of acute myocardial infarction (AMI) or death in patients who survived an episode of high-risk NSTEACS.The study involved 972 consecutive patients with high-risk NSTEACS who survived after hospital admission. Readmission for AHF was selected as the main exposure variable, and its association with subsequent AMI or all-cause death was assessed using Cox proportional hazards models for time-dependent covariates that also included …
Effectiveness of the Relative Lymphocyte Count to Predict One-Year Mortality in Patients With Acute Heart Failure
Several works have endorsed a significant role of the immune system and inflammation in the pathogenesis of heart failure. As indirect evidence, an association between a low relative lymphocyte count (RLC%) and worse outcomes found in this population has been suggested. Nevertheless, the role of RLC% for risk stratification in a large and nonselected population of patients with acute heart failure (AHF) has not yet been determined. Thus, the aim of this study was to determine the association between low RLC% and 1-year mortality in patients with AHF and consequently to define whether it has any role for early risk stratification. A total of 1,192 consecutive patients admitted for AHF were a…
Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes
[EN] Introduction and objectives: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Methods: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate…